Supplying physicians with reports on stroke risk and ICD-detected AF increased appropriate oral anticoagulation use to 72.6% compared with 56.8% in control centers (P<0.001).
Cohort (n=3,438)
Yes
Does providing specific reports on stroke risk factors and ICD-detected AF improve adherence to oral anticoagulation guidelines in patients with ICDs?
Providing physicians with specific reports on stroke risk factors and ICD-detected AF significantly improves adherence to oral anticoagulation guidelines.
Absolute Event Rate: 72.6% vs 56.8%
p-value: p=<0.001
BACKGROUND: Atrial fibrillation (AF) is a well-established risk factor for stroke and thromboembolism and is a frequent comorbid arrhythmia in patients with implantable cardioverter-defibrillators (ICDs). The Anticoagulation Use Evaluation and Life Threatening Events Sentinels (ANGELS) of AF project was a medical care program aimed at supporting adherence to oral anticoagulation (OAC) guidelines for thromboprophylaxis through the use of ICD AF diagnostics. METHODS AND RESULTS: Fifty Italian cardiology clinics followed 3438 patients with ICDs. In a subgroup of 15 centers (the ANGELS of AF centers), cardiologists attending to follow-up visits were supplied with specific reports describing stroke risk factors and risk scores (American College of Chest Physicians and CHADS(2) congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack), AF occurrence and duration, and current antithrombotic therapy for patients with AF, especially those with a CHADS(2) score >0 and not on OAC therapy. The remaining centers represented a control group of patients as a comparison of OAC use. In the ANGELS of AF centers, 709 (36%) patients had AF described either in their clinical history (n=426 22%) or as new-onset AF (n=257 14%). Among 683 (96%) patients with CHADS2 score >0, 209 (30.6%) were not taking an OAC. Appropriate OAC therapy was prescribed in 10% (22/209) of patients after evaluation of ANGELS of AF reports. The percentage of patients on OAC therapy, as indicated by guidelines, increased during follow-up from 46.1% at baseline, to 69.4% at the stroke risk evaluation phase, to up to 72.6% at the end of the observation period. In control centers, corresponding figures were 46.9% at baseline and 56.8% at the end of the observation period (P<0.001 versus ANGELS of AF group). CONCLUSIONS: The ANGELS of AF project demonstrates the possibility to improve OAC use in accordance with available guidelines for stroke risk reduction in AF by supplying attending physicians with reports about patients risk factors and AF information from continuous ICD monitoring.
Boriani et al. (2012) conducted a cohort in Atrial fibrillation in patients with implantable cardioverter-defibrillators (n=3,438). ANGELS of AF project (specific reports on stroke risk and ICD-detected AF) vs. Standard care (control centers) was evaluated on Percentage of patients on OAC therapy as indicated by guidelines at the end of the observation period (p=<0.001). Supplying physicians with reports on stroke risk and ICD-detected AF increased appropriate oral anticoagulation use to 72.6% compared with 56.8% in control centers (P<0.001).